右美托咪定在冠心病病人腹部手术中的应用

USE OF DEXMEDETOMIDINE DURING ABDOMINAL SURGERY IN PATIENTS WITH CORONARY HEART DISEASE

目的观察右美托咪定在冠心病病人腹部手术围术期应用的可行性。方法选取择期行上腹部手术的冠心病病人60例，AsAⅡ～Ⅲ级，NYHAII～Ⅲ级，随机分为观察组和对照组，每组30例。两组均采用静吸复合全身麻醉，观察组在麻醉诱导前20rain给予右美托咪定O．5μg／（kg·h）的维持剂量持续泵注，对照组给予相同容积的生理盐水持续泵注，直至手术结束。观察两组病人麻醉前、诱导后、气管插管即刻、拔管即刻血流动力学指标变化，同时记录插管、拔管时心率〉90min、需艾司洛尔控制心率的病人例数及ST段下降≥0．5mV发生率。结果麻醉诱导后两组心率（HR）、平均动脉压（MAP）均较基础值明显下降（F=17．163、10．683，q=6．158～10．738，P〈0．05）；麻醉诱导后、气管插管即刻、拔管即刻观察组HR、MAP明显低于对照组（t=1.958～6．575，P〈0．05）；观察组插管即刻、拔管即刻需艾司洛尔控制心率及ST段出现心肌缺血性改变例数均少于对照组，差异有统计学意义（x2=8．076、9．675，P〈0．05）。结论右美托咪定用于冠心病病人腹部手术，能维持围术期血流动力学指标平稳，并且具有心肌保护作用。

Objective To observe the feasibility of perioperative use of dexmedetomidine for abdominal surgeries in pa- tients with coronary heart disease. Methods Sixty ASA Ⅱ or Ⅲ patients with coronary heart disease （NYHA II or Ⅲ ） sche- duled for selective upper abdominal surgeries were evenly randomized to observation and control groups. The patients in both groups received eombined intravenous inhalation general anesthesia. The patients in the observation group were given a manitenance dosage of continuous intravenous 0.5 /μg/（kg · h） of dexmedetomidine starting from 20 min before anaesthesia induction until the end of operation, and an equal volume of normal saline was given to those in the control group. Changes of the hemodynamies of patients in both groups were monitored before anesthsia, after induction, at intubation, extubation, and at the same time, the cases of those with heart rates ~ 90 min-~ at intubation and extubation that needed esmolol to control the heart rates and the incidence of ST segment lowered ~0.5 mV were recorded. Results The heart rates and mean arterial pressure were lower in both groups af- ter anesthesia induction than before （F = 17.163,10.683 ;q = 6.158-- 10.738 ;P 〈0.05）, After anesthesia induction, immediately at intubation and extubation, the heart rates and mean arterial pressure in patients in the observation group were lower than the con- t rol group （t = 1.958-- 6.575, P 〈0.05）. The cases that needed esmolol to control heart rates and that showed ST-segment changes indicating myocardial ischemia were less in the observation group than the control, the differences between the two groups being significant （X2=8.076,9.675;P〈0.05）. Conclusion Applying dexmedetomidine for operation on abdominal region in patients with coronary heart diseases can stabilize patient＇s perioperative hemodynamics and play myocardial protection.